Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2018

Open Access 01-12-2018 | Case report

Klebsiella pneumoniae liver abscess: a case report

Authors: P. N. S. Premathilake, W. K. S. Kularatne, J. P. K. Jayathilake, S. D. N. Senadhira

Published in: Journal of Medical Case Reports | Issue 1/2018

Login to get access

Abstract

Background

Liver abscess has formerly been a polymicrobial infection. Currently, liver abscess due to Klebsiella pneumoniae is increasingly reported, predominantly in Southeast Asia for unknown reasons. Liver abscess due to Klebsiella pneumonia has never been previously reported in Sri Lanka.

Case presentation

A 63-year-old Sinhalese man with diabetes mellitus and a poor glycemic control presented with fever, loose stools, and loss of appetite of 1 week’s duration. An examination was unremarkable apart from a mild non-tender hepatomegaly. Investigations indicated a septic process with neutrophil leukocytosis, thrombocytopenia, and raised inflammatory markers with acute kidney injury. Sonography of his abdomen revealed a large liver abscess with two blood cultures positive for Klebsiella pneumoniae. He made a complete recovery following aspiration of the abscess and treatment with intravenously administered ceftriaxone.

Conclusion

Liver abscess due to Klebsiella pneumoniae is an emerging infection and most commonly reported from Southeast Asia. In Sri Lanka, further studies are necessary to understand the epidemiology and modes of spread. Furthermore, a high index of suspicion is essential as early detection is the key to successful treatment and prevention of complications.
Literature
1.
go back to reference Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12(11):881–7.CrossRef Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12(11):881–7.CrossRef
2.
go back to reference Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005;100(2):322–31.CrossRef Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005;100(2):322–31.CrossRef
3.
go back to reference Lin JC, Siu LK, Fung CP, Tsou HH, Wang JJ, Chen CT, et al. Impaired phagocytosis of capsular serotypes K1 or K2 Klebsiella pneumoniae in type 2 diabetes mellitus patients with poor glycemic control. J Clin Endocrinol Metab. 2006;91(8):3084–7.CrossRef Lin JC, Siu LK, Fung CP, Tsou HH, Wang JJ, Chen CT, et al. Impaired phagocytosis of capsular serotypes K1 or K2 Klebsiella pneumoniae in type 2 diabetes mellitus patients with poor glycemic control. J Clin Endocrinol Metab. 2006;91(8):3084–7.CrossRef
4.
go back to reference Seeto RK, Rockey DC. Pyogenic liver abscess changes in etiology, management, and outcome. Medicine. 1996;75(2):99–113.CrossRef Seeto RK, Rockey DC. Pyogenic liver abscess changes in etiology, management, and outcome. Medicine. 1996;75(2):99–113.CrossRef
5.
go back to reference Brook I, Frazier EH. Microbiology of liver and spleen abscesses. J Med Microbiol. 1998;47(12):1075–80.CrossRef Brook I, Frazier EH. Microbiology of liver and spleen abscesses. J Med Microbiol. 1998;47(12):1075–80.CrossRef
6.
go back to reference Moore-Gillon JC, Eykyn SJ, Phillips I. Microbiology of pyogenic liver abscess. Br Med J (Clin Res Ed). 1981;283(6295):819–21.CrossRef Moore-Gillon JC, Eykyn SJ, Phillips I. Microbiology of pyogenic liver abscess. Br Med J (Clin Res Ed). 1981;283(6295):819–21.CrossRef
7.
go back to reference Rubin RH, Swartz MN, Malt R. Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Am J Med. 1974;57(4):601–10.CrossRef Rubin RH, Swartz MN, Malt R. Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Am J Med. 1974;57(4):601–10.CrossRef
8.
go back to reference Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11(4):589–603.CrossRef Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11(4):589–603.CrossRef
9.
go back to reference Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986;146(10):1913–6.CrossRef Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986;146(10):1913–6.CrossRef
10.
go back to reference Chung DR, Lee H, Park MH, Jung SI, Chang HH, Kim YS, et al. Fecal carriage of serotype K1 Klebsiella pneumoniae ST23 strains closely related to liver abscess isolates in Koreans living in Korea. Eur J Clin Microbiol Infect Dis. 2012;31(4):481–6.CrossRef Chung DR, Lee H, Park MH, Jung SI, Chang HH, Kim YS, et al. Fecal carriage of serotype K1 Klebsiella pneumoniae ST23 strains closely related to liver abscess isolates in Koreans living in Korea. Eur J Clin Microbiol Infect Dis. 2012;31(4):481–6.CrossRef
11.
go back to reference Fung CP, Lin YT, Lin JC, Chen TL, Yeh KM, Chang FY, et al. Klebsiella pneumoniae in gastrointestinal tract and pyogenic liver abscess. Emerg Infect Dis. 2012;18(8):1322.CrossRef Fung CP, Lin YT, Lin JC, Chen TL, Yeh KM, Chang FY, et al. Klebsiella pneumoniae in gastrointestinal tract and pyogenic liver abscess. Emerg Infect Dis. 2012;18(8):1322.CrossRef
12.
go back to reference Turton JF, Englender H, Gabriel SN, Turton SE, Kaufmann ME, Pitt TL. Genetically similar isolates of Klebsiella pneumoniae serotype K1 causing liver abscesses in three continents. J Med Microbiol. 2007;56(5):593–7.CrossRef Turton JF, Englender H, Gabriel SN, Turton SE, Kaufmann ME, Pitt TL. Genetically similar isolates of Klebsiella pneumoniae serotype K1 causing liver abscesses in three continents. J Med Microbiol. 2007;56(5):593–7.CrossRef
13.
go back to reference Lindstrom ST, Healey PR, Chen SC. Metastatic septic endophthalmitis complicating pyogenic liver abscess caused by Klebsiella pneumoniae. Intern Med J. 1997;27(1):77–8. Lindstrom ST, Healey PR, Chen SC. Metastatic septic endophthalmitis complicating pyogenic liver abscess caused by Klebsiella pneumoniae. Intern Med J. 1997;27(1):77–8.
14.
go back to reference Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26(6):1434–8.CrossRef Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26(6):1434–8.CrossRef
15.
go back to reference Chang FY, Chou MY. Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens. J Formos Med Assoc. 1995;94(5):232–7.PubMed Chang FY, Chou MY. Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens. J Formos Med Assoc. 1995;94(5):232–7.PubMed
16.
go back to reference Qu K, Liu C, Wang ZX, Tian F, Wei JC, Tai MH, et al. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia. World J Gastroenterol. 2012;18(23):2948.CrossRef Qu K, Liu C, Wang ZX, Tian F, Wei JC, Tai MH, et al. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia. World J Gastroenterol. 2012;18(23):2948.CrossRef
17.
go back to reference Lee SS, Chen YS, Tsai HC, Wann SR, Lin HH, Huang CK, et al. Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. Clin Infect Dis. 2008;47(5):642–50.CrossRef Lee SS, Chen YS, Tsai HC, Wann SR, Lin HH, Huang CK, et al. Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. Clin Infect Dis. 2008;47(5):642–50.CrossRef
18.
go back to reference Siu LK, Fung CP, Chang FY, Lee N, Yeh KM, Koh TH, et al. Molecular typing and virulence analysis of serotype K1 Klebsiella pneumoniae strains isolated from liver abscess patients and stool samples from noninfectious subjects in Hong Kong, Singapore, and Taiwan. J Clin Microbiol. 2011;49(11):3761–5.CrossRef Siu LK, Fung CP, Chang FY, Lee N, Yeh KM, Koh TH, et al. Molecular typing and virulence analysis of serotype K1 Klebsiella pneumoniae strains isolated from liver abscess patients and stool samples from noninfectious subjects in Hong Kong, Singapore, and Taiwan. J Clin Microbiol. 2011;49(11):3761–5.CrossRef
19.
go back to reference Chang WN, Huang CR, Lu CH, Chien CC. Adult Klebsiella pneumoniae meningitis in Taiwan: an overview. Acta Neurol Taiwanica. 2012;21(2):87–96. Chang WN, Huang CR, Lu CH, Chien CC. Adult Klebsiella pneumoniae meningitis in Taiwan: an overview. Acta Neurol Taiwanica. 2012;21(2):87–96.
20.
go back to reference Hsieh MJ, Lu TC, Ma MH, Wang HP, Chen SC. Unrecognized cervical spinal epidural abscess associated with metastatic Klebsiella pneumoniae bacteremia and liver abscess in nondiabetic patients. Diagn Microbiol Infect Dis. 2009;65(1):65–8.CrossRef Hsieh MJ, Lu TC, Ma MH, Wang HP, Chen SC. Unrecognized cervical spinal epidural abscess associated with metastatic Klebsiella pneumoniae bacteremia and liver abscess in nondiabetic patients. Diagn Microbiol Infect Dis. 2009;65(1):65–8.CrossRef
21.
go back to reference Hu BS, Lau YJ, Shi ZY, Lin YH. Necrotizing fasciitis associated with Klebsiella pneumoniae liver abscess. Clin Infect Dis. 1999;29(5):1360–1.CrossRef Hu BS, Lau YJ, Shi ZY, Lin YH. Necrotizing fasciitis associated with Klebsiella pneumoniae liver abscess. Clin Infect Dis. 1999;29(5):1360–1.CrossRef
22.
go back to reference Kohler JE, Hutchens MP, Sadow PM, Modi BP, Tavakkolizadeh A, Gates JD. Klebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere. Surg Infect. 2007;8(2):227–32.CrossRef Kohler JE, Hutchens MP, Sadow PM, Modi BP, Tavakkolizadeh A, Gates JD. Klebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere. Surg Infect. 2007;8(2):227–32.CrossRef
23.
go back to reference Abdul-Hamid A, Bailey SJ. Klebsiella pneumoniae liver abscess and endophthalmitis. BMJ Case Rep. 2013;2013:bcr2013008690.CrossRef Abdul-Hamid A, Bailey SJ. Klebsiella pneumoniae liver abscess and endophthalmitis. BMJ Case Rep. 2013;2013:bcr2013008690.CrossRef
24.
go back to reference Sheu SJ, Kung YH, Wu TT, Chang FP, Horng YH. Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan. Retina. 2011;31(10):2026–31.CrossRef Sheu SJ, Kung YH, Wu TT, Chang FP, Horng YH. Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan. Retina. 2011;31(10):2026–31.CrossRef
25.
go back to reference Alsaif HS, Venkatesh SK, Chan DS, Archuleta S. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumoniae. Radiology. 2011;260(1):129–38.CrossRef Alsaif HS, Venkatesh SK, Chan DS, Archuleta S. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumoniae. Radiology. 2011;260(1):129–38.CrossRef
26.
go back to reference De Silva GN, Pathirana K. Pyogenic liver abscess. Sri Lanka J Child Health. 2009;30(4):110.CrossRef De Silva GN, Pathirana K. Pyogenic liver abscess. Sri Lanka J Child Health. 2009;30(4):110.CrossRef
Metadata
Title
Klebsiella pneumoniae liver abscess: a case report
Authors
P. N. S. Premathilake
W. K. S. Kularatne
J. P. K. Jayathilake
S. D. N. Senadhira
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2018
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-018-1924-4

Other articles of this Issue 1/2018

Journal of Medical Case Reports 1/2018 Go to the issue